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Thyroid or Adrenals


I've been struggling for months now with a large range of symptoms. I've been thru 5 different doctors and have managed to get most of the lab work done that I need. However, my current doctor (internist) is stumped and I feel we are wasting precious time. Any help would be appreciated if someone can manage to get thru the long lists below:

To start, I'm a 35 yr old female
Symptoms: extreme fatigue, weakness, difficulty staying asleep in early a.m., hair breaking and falling out, always cold (especially hands), dry skin, dry eyes, dry mouth, weight gain (30 lbs in 3 months), inability to lose weight despite healthy eating (low carb and sugar), short term memory loss, difficulty concentrating, inability to handle stress, very emotional, joint pain, skin pain, muscle pain, muscles feel shredded after slight exercise, eye strain & very sensitive to bright light, mood swings

Here's the labs I've had done with the ranges

Ferritin 11.7  (11.0-307.0)
Iron 73  (50-170)
transferrin saturation 18%  (20-50)
-since these tests I am on Iron supplements and have had 2 IV iron infusions which seem to have helped a bit

TSH 1.08 (0.34-5.60)
Free T3 2.69 (2.50-3.90)
Free T4 .83 (.61-1.12)
Thyroglob Ab <1.0  (0.0-0.9)
Thyroglobulin 8.0  (1.5-38.5)

Aldosterone <1.0  (0.0-30.0)
Cortisol Serum  2.9  (8.7-22.4 ug/dL)

Cortisol Stimulation Test results:
Cortisol base 3.5
30 minutes  10.7
60 minutes 14.1
(notes say a normal response should rise greater than 7 ug/dL from baseline with a peak response greater than 18)

* Since I "rose" 7.2 points but failed to hit 18 it was noted that there is a problem. Obviously my a.m. cortisol level is very low but the dr cannot come up with an answer. I have received no treatment on this and I feel it has gotten worse since this test which was on 8/14/15

The dr has ordered a 24 hr urine test which I haven't completed yet.  Needless to say, I have many other labs but felt these were the basics.  

I feel I have raging hypothyroid symptoms but since my numbers don't reveal the problem it's blown off.  My Cort Stim test didn't give a glaring "Addison's" result so it's in limbo. I've noticed more problems with hypoglycemia lately also.

Any help is appreciated!
3 Responses
Avatar universal
Apparently your doctor is unaware of central hypothyroidism, characterized by relatively low TSH and also low levels of Free T4 and Free T3, which are the biologically active thyroid hormones.  TSH is a pituitary hormone that is affected by so many things that at best it is only an indicator, to be considered along with more important indicators such as symptoms and also levels of Free T4 and Free T3.  Members say that relief from hypo symptoms required Free T4 at the middle of its range, at minimum and Free T3 in the upper third of its range, or as necessary to relieve symptoms..  Along with this morning cortisol levels should be in the upper part of the range, Vitamin D about 55-60, B12 in the upper part of its range, and ferritin about 70 minimum.  DHEA should be about middle of its range.

So you are going to have to address a number of areas.  You need thyroid med in order to raise your Free T4 and Free T3 levels as mentioned above.  Before even doing that you need to address your low cortisol level to bring it up significantly before starting on thyroid med.  Along with that you need to supplement your terribly low ferritin level with daily supplements of iron.  Some good forms of iron are ferrous fumarate, ferrous sulfate, and ferrous bisglycinate.  Vitamin D  and B12 also need to be tested and supplemented as needed to bring D up to 55-60, and B12 into the upper end of its range.

When you are ready to start on thyroid meds, keep in mind that a good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 levels as needed to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results and especially not TSH results.  You can get some good insight from this link written by a good thyroid doctor.  Note that in the left hand margin there is a link called "The Hormones" which will provide some good info on cortisol and DHEA.

Avatar universal

First, thank you so much for responding so quickly! I truly appreciate it!

I've found a huge well of info on the Stop The Thyroid Madness website and books which is why the majority of those tests were run to begin with. My doctor is an Internist and I feel he truly desires to help but he is feeling his way along. He's referred me to two different endos but the earliest appt I could get was December and the other in February.  
Right now his main concern has been the Adrenal issues since the Cort Stim test was so odd.  That is my biggest concern also since my husband has full blown Addison's. I'm hoping that my problem is along the lines of Adrenal Fatigue which can be treated and maybe healed with time. However, it's getting worse and the process of getting answers is not a fast one, unfortunately. I also wondered if Secondary Adrenal Insufficiency was a possibility

I've had absolutely no luck with the Hypothyroid stuff. No matter how many drs I go to they all say it's normal and walk away. I absolutely agree that if you have both Adrenal issues and Thyroid that you do better if you can fix the adrenals first. From what I've gathered if you try and fix the thyroid problems first it's a struggle to get it balanced with the adrenal problems

My Vitamin D tested below low normal at 28.5 (range 30-100) and I'm supplementing that.
I'm taking Iron Sulfate and the Iron IV infusions to raise that level. I'll go back to the hematologist in a month or so to be retested to see if I need more IV.
My B12 was >1500 (range 180-914) and I was taking supplements but stopped since it was so high

I will definitely use the link you posted and I appreciate any additional insight or suggestions offered! I've been struggling along and researching like crazy. I feel like I have a huge amount of info but no luck getting a doctor to act

Avatar universal
Hi again,

Just remembered that I failed to mention that I had an Ultrasound on my thyroid back in April/May.  It showed 2 Nodules. That appt was with the worst endo ever and his reply to my questioning the nodules was "we'll check them again in a year". A Year!  No other comment which was insane (I thought) since I was there for thyroid issues and I always thought that something like that should have a biopsy?
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